Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, United States of America (USA).

ABSTRACT

Objective: To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010.

Methods: We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD's first edition of A system of health accounts manual, (2000).

Findings: We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/.

Conclusion: Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.

Mentions:
In some countries, the combination of the given and generated not-specified-by-kind components made up more than 75% of expenditure reported in financing source matrices (Fig. 3). The proportions for other data types are shown in Fig. 4, Fig. 5 and Fig. 6 (available at: http://www.who.int/bulletin/volumes/93/14/07-145235). In deriving these figures, we used the total number of NHAs available in the denominator, even if the breakdowns of type matrices were not provided. For example, China reported totals for its health provider matrices but gave no details of components. Consequently, 100% of expenditure reported by health provider type was categorized as not-specified-by-kind. Overall, the size of the generated not-specified-by-kind component was greatest for financing source matrices and health provider matrices. Data on financing sources were produced infrequently. Fig. 7 shows the magnitude of the generated not-specified-by-kind component as a percentage of the total not-specified-by-kind component. For each country, the percentage was estimated across all available matrices. The generated not-specified-by-kind component was at least 50% of the total not-specified-by-kind component for 46% (54/117) of countries. For all OECD countries for which a value for the generated not-specified-by-kind component was required, that component comprised more than 80% of the total not-specified-by-kind component. For OECD countries, therefore, the not-specified-by-kind component was mostly needed to compensate for the sum of components within a matrix not equalling the total.

Mentions:
In some countries, the combination of the given and generated not-specified-by-kind components made up more than 75% of expenditure reported in financing source matrices (Fig. 3). The proportions for other data types are shown in Fig. 4, Fig. 5 and Fig. 6 (available at: http://www.who.int/bulletin/volumes/93/14/07-145235). In deriving these figures, we used the total number of NHAs available in the denominator, even if the breakdowns of type matrices were not provided. For example, China reported totals for its health provider matrices but gave no details of components. Consequently, 100% of expenditure reported by health provider type was categorized as not-specified-by-kind. Overall, the size of the generated not-specified-by-kind component was greatest for financing source matrices and health provider matrices. Data on financing sources were produced infrequently. Fig. 7 shows the magnitude of the generated not-specified-by-kind component as a percentage of the total not-specified-by-kind component. For each country, the percentage was estimated across all available matrices. The generated not-specified-by-kind component was at least 50% of the total not-specified-by-kind component for 46% (54/117) of countries. For all OECD countries for which a value for the generated not-specified-by-kind component was required, that component comprised more than 80% of the total not-specified-by-kind component. For OECD countries, therefore, the not-specified-by-kind component was mostly needed to compensate for the sum of components within a matrix not equalling the total.

Bottom Line:
Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types.Abstract available from the publisher.

Affiliation:
Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, United States of America (USA).

ABSTRACT

Objective: To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010.

Methods: We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD's first edition of A system of health accounts manual, (2000).

Findings: We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/.

Conclusion: Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.